In 1992 JAMA published an article by the Evidence-Based Medicine Working Group focusing on the role of evidence-based medicine (EBM) in medical education.1 Although the term evidence-based medicine first appeared in the published literature the prior year,2 the JAMA publication brought both the label and the underlying philosophy to the attention of a wider medical community.

The article was audacious in suggesting that EBM represented a new paradigm in the teaching and practice of medicine by deemphasizing unsystematic clinical observations, pathophysiological inference, and authority. The article honored traditional skills (eg, understanding biology, demonstrating empathy), but emphasized new skills that learners must acquire and use: question formulation, search and retrieval of the best available evidence, and critical appraisal of the study methods to ascertain the validity of results. The article aggressively presented EBM as a fundamentally new approach.

Preface: These recommendations, the second set developed for the International Headache Society (IHS) by its Ethics Subcommittee, evolved over 3 years. This extended period allowed time for public consultation, an important part of the formulation process, and for consequent revision. The recommendations were presented in this final form to IHS Council in late 2005, and approved for publication in Cephalalgia. The delay from then until now would have been better avoided. The reasons for it, which did not lie with the Subcommittee, are not of current interest. What matters is that these recommendations remain entirely relevant to their purpose. In one area – the registration of clinical trials – matters have moved on in the interim. As the Subcommittee anticipated, registration of trials is becoming standard practice. This goal is not yet achieved, but laudable and largely voluntary initiatives by the pharmaceutical industry have brought about much recent progress. Clear international consensus has yet to emerge on what needs to be included in a clinical trials registry, and when. This does not help, since it is not entirely certain what the desired end is. But it seems likely that, with or without further regulation, this end will be both clear and in sight in not too long. Headache will benefit, along with all other fields of medicine.